Abstract
Previous incisions around the knee may complicate subsequent total knee replacement (TKR) surgery because they can lead to skin problems, with wound breakdown and a risk of sepsis.
Our database contains details of 925 TKRs, 851 primary and 74 revision procedures. Of the 851 primary TKR patients, 368 had previously undergone knee surgery, 72 of them more than once. Twenty of the 74 patients who underwent revision TKR had undergone one previous procedure (excluding the primary TKR), and 24 had undergone multiple procedures. We clinically reviewed 133 TKRs, classifying previous procedures into midline (24), medial (50), lateral (26) and transverse (13) procedures. In 53 cases there had been previous arthroscopic procedures. Excluding the arthroscopies, previous scars were followed in 20 cases, partially followed in 11 cases and ignored in 53 cases.
Following up patients for a minimum of six months, we saw only six cases with minor wound edge slough. These did not require further surgery. Three of the six patients were in the group of 442 with previous scars, and three in the group of 483 without previous scars. All patients had spinal anaesthesia, peri-operative oxygen, vacuum drainage and a delayed knee-bending program, which we believe contributed to the low incidence of wound problems.
We believe that previous scars should be followed if they are approximately in the line of a normal midline TKR incision, and that scars beyond the midline can be ignored without increasing the risk of skin necrosis.
The abstracts were edited by Prof. M.B.E. Sweet. Correspondence should be addressed to him at the Department of Orthopaedic Surgery, Medical School, University of the Witwatersrand, 7 York Road, Parktown, 2193 South Africa
